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Sindrome di Alport (ATS) nefropatia ereditaria progressiva
eterogenea dal punto vista clinico e genetico
CRITERI CLINICI
Storia familiare positiva per ematuria o insufficienzarenale cronica (IRC)
Alterazioni ultrastrutturali della membrana basale glomerulare (GMB)
Anomalie oculari (lenticono, macchie perimaculari, erosioni corneali ricorrenti)
Ipoacusia neurosensoriale per le alte frequenze
0.3-2.6% pazienti che sviluppano ESRD in Europa
Sindrome di Alport (ATS)-malattia delle membrane basali
(del collagene di tipo IV)
•X-legata (circa il 90% dei casi) – gene COL4A5
•autosomica recessiva – geni COL4A3 e COL4A4
•autosomica dominante – geni COL4A3 e COL4A4
Gubler MC (2008) Inherited diseases of the glomerular basement membraneNat Clin Pract Nephrol 4: 24–37, 2007
Kalluri R. Nature Reviews, 2003
Kalluri R. Nature Reviews, 2003
Gubler MC (2008) Inherited diseases of the glomerular basement membraneNat Clin Pract Nephrol 4: 24–37, 2007
Gubler MC (2008) Inherited diseases of the glomerular basement membraneNat Clin Pract Nephrol 4: 24–37, 2007
Figure 5 Immunohistological analysis of the distribution of the
α5(IV) collagen chain
ATS ARcontrollo Maschio ATS XL Femmina ATS XL
Gubler MC (2008) Inherited diseases of the glomerular basement membraneNat Clin Pract Nephrol 4: 24–37, 2007
I
II
III
64aa IRC lieve
ESRD a 33aa
ipoacusia
ESRD a 18aa
ipoacusia
ESRD a 22aa
ipoacusia
Microematuria intermittente
Jais JP et al, J Am SocNephrol. 2000 Apr;11(4):649-57.
Jais JP et al, J Am Soc Nephrol.2003 Oct;14(10):2603-10.
Jais JP et al, J Am Soc Nephrol.2003 Oct;14(10):2603-10.
3209insA w
3386del27 w
3209insA 3386del273209insA 3386del27ww
COL4A317 y
Microhematuria
macrohematuria
CRF (creatininemia 2 mg%)
Bilateral mixed hearing loss
Delayed growth
9 y
Microhematuria
macrohematuria
Creatinininemia 0,4 mg%
43 y
Microhematuria
Macrohematuria
Creatininemia 0,9 mg%
AUTOSOMAL RECESSIVE ALPORT SYNDROME
Longo I, et al. Nephrol Dial Transplant 2006;21(3):665-71.
40del24 w ww
40del24 w
COL4A3
14 y
Microhematuria
Mild proteinuria
Normal renal function
46 y
Microhematuria
Macrohematuria
High tone hypoacusia
AUTOSOMAL DOMINANT ALPORT SYNDROME
Longo I et al., Kidney Int. 2002 Jun;61(6):1947-56Pescucci C. et al. Kidney Int. 2004;65(5):1598-603
54 y
CRF
88 y death
Dialysis since the age of 84
Bilateral neurosensory hearing loss
67 y
Microhematuria
proteinuria
CRF (creatininemia 1,4mg%)
Bilateral neurosensory
hearing loss
G1045Vw
43-20 y
Microhematuria
COL4A3
G1045Vw
AUTOSOMAL DOMINANT ALPORT SYNDROME
Pescucci C, et al. Kidney Int. 2004;65(5):1598-603.
II
III
I90 aa
non penetrante+/-
+/- -/-+/- -/--/-
+/- -/-
p.C1634SCOL4A4
Pescucci C, et al. Kidney Int. 2004;65(5):1598-603.
Marcocci E, et al. Nephrol Dial Transplant. 2009;24(5):1464-71.
Marcocci E, et al. Nephrol Dial Transplant. 2009;24(5):1464-71.
Microematuria dall’età di 48 anni (creatininemia1.4 mg%)
31 anniMicroematuria Normale funzione renale
Trapianto renaleall’età di 52 anni
Arriva dallo specialista nefrologocon diagnosi di sindromedi Alport X-legato erichiesta di analisi del gene COL4A5
Dopo la consulenza genetica
si decide di analizzare i geni COL4A3-4invece del gene COL4A5
Mutazione nel gene COL4A4 e
diagnosi di sindrome di Alport
autosomico dominante
family GST
G1198S w
COL4A3
39 y
Microhematuria
Proteinuria
Normal renal function
AUTOSOMAL DOMINANT ALPORT SYNDROME, or BFH ?
Longo I. et al, Kidney Int. 2002 Jun;61(6):1947-56.
COL4A5 heterozygous female
CRF
COL4A5 hemizygous male
Non sympthomaticcarrier
Microhematuria CRF
Only 15%
COL4A3/4 homozygous, male/female
AutosomalRecessiveAlport syndrome
COL4A3/4 heterozygous, male/female
Non sympthomaticcarrier
BenignFamilialHematuria
AutosomalDominantAlport syndrome